3.5 Years Out

Technically, it was three years in January, but I prefer to put off this appointment until spring or summer, because it’s nicer for me. It’s not a life-or-death type appointment, something perfunctory that needs doing, and well, rather than NOT DO IT AT ALL, I do it on my own terms, and this year it was June.

All things considered (the Wellbutrin experiment + Cymbalta experiment + PMS + I didn’t do my “primary poop” of the day—yes, there’s a preliminary, primary, and secondary poop of my day!), all in all, weight gain is roughly four pounds, negligible from their point of view.

Between me maintaining my weight and the numbers on all my blood work, all fingers point in the direction of me remaining on point, compliant as a WLS post op patient. Now if only, I could get a handle on my depression, anxiety and pain, which I feel is hindering my goals for a wee bit more weight loss as well as my goal of becoming more active.

Mind you, my blood pressure is high normally and I’m on an ACE inhibitor for that, which is normally controlled. I arrived at the appointment early and sat and crocheted while I waited. So I was about as peaceful as could be, before they called my name. They weighed me, then took my pressure with one of those automated BP cuffs, and I was appalled at the numbers: 165/120, which, no doubt were not accurate. My norm runs about 138/80 or 138/90. This surely was a mistake. Regardless, on paper, that’s the bp on record for yesterday’s appointment.

The elevated bp is distressing enough as it is, but when coupled up with what evolved next, I really have a wave of conflicting emotions and thoughts swirling through my head.

I mentioned in passing about my pain, depression, and anxiety hindering my goals, as well as messing with my overall sense of well being. The doctor spit-balled a few ideas:

Him: Wellbutrin?

Me: Tried it in November, and it made me very ragey, and not in a productive way.

Him: Cymbalta?

Me: Tried it at the beginning of this year. I gained weight, it caused horrid painful constipation and did nothing for my overall pain or anxiety.

Him: Topamax?

Me: I tried that YEARS ago for my migraines, plus, my endocrinologist assured me I’d lose weight on it. And much like with the Metformin which everyone promised I’d lose weight on, I never did.

Him: Perhaps lamictal? What about lyrica for the pain?

Me: I remain unconvinced that the side effects are a value added trade off for the symptoms.

And then with that, he did the most outlandish thing. Perhaps it was his sign that I was fishing around for an Rx, ANY Rx? I want the RIGHT Dx and the OPTIMAL Rx is what I want.  I don’t need a bariatric surgeon going on fishing expedition regarding my psychopharmacological needs. All that said, I found it more than a bit disconcerting as well as irresponsible that he wrote me an Rx for Phentermine.  Between the elevated BP plus the fact that I don’t want things to AGITATE me, I see this move as thoroughly confusing.

First order of business today was to drop an email to my ReproEndoGuy, whose only response back to me, all in caps was:  DO NOT TAKE PHENTERMINE!!! I guess I’ll have to wait on his recommendation for a psychiatrist or a psychopharmacologist. Perhaps my psychotherapist might be able to recommend a guy? One more thing for the TO DO list this year.

The appointment up until that point was decent enough, and actually was much better than I anticipated it to be (which I guess also is part of the dysthymic nature of my depression—that negative inward talk, sense of dread and failure that invades everything. And despite it, I power through the best I can. Most days I can fake it to make it, and other days I just need to curl up in a ball and be left alone, as I’m no good for polite civilization.

As is my norm after the visit with the surgeon, I usually plan a pop in at Murray’s Sturgeon for a celebratory tuna sandwich and stock up on other delicacies. But yesterday was warm and I didn’t have an insulated bag with me, and didn’t think that everything would “keep” in a plain sack. So, in lieu of my traditional tuna on rye, I got their smoked whitefish salad on rye, with onions, and a pickled herring filet. Traditional place to eat, is at the bench at the traffic median on the corner. And as I sat there, and unwrapped my sandwich, I had the conscious awareness and even looked upward at the sun, then back at the pristine whiteness of the whitefish salad tucked between two pieces of rye and said to myself, “It doesn’t get any better than this.”

Little did I realize, instinctively, all along, every single trek into NYC for medical appointments, every single trek I have planned a meal or planned stops throughout the day. Little did I realize this “reward system” of sorts I’ve structured for my days in NYC actually help stimulate my dopamine.

In keeping with my new way of being, this “growth orientedness” as I am calling it, I am going to try to focus on stimulating or elevating my dopamine, or my serotonin, or my oxytocin levels in small, but hopefully productive ways.

Dopamine: Just keep doing the things that bring me joy. If I do set a goal and follow through, enjoy the reward! And sometimes just doing good (for others, or even strangers) is its own reward. So I’ve got a few parcels to be mailed out soon.

Seratonin: Well, I guess I should revamp my protein shake regimen, and not mix it with coffee. I think I’ll start doing my banana-peanut butter shake again, as the power-punch of flavor is a boost. And also? Try to spend more time outdoors.

Oxytocin: More hugs and more orgasms from/with the husband, as well as more massages, and more regular pedicures/manicures. There is no disputing the benefit of just simple human, skin on skin contact.

Endorphin: Let’s not get ahead of ourselves! That will require physical exertion! Pain pain pain. So no. Also? I do not like to sweat.

So yes. With the depression, and the pain, I am fighting the Blerch. Even though I recognize I’ve been half assing the physical therapy since May by “under-committing to avoid over-regretting,” I feel it hasn’t made all that much of a difference, overall in the pain issues. I am more aware of my abdominal muscles and do try to hoist them up and suck it in while walking, but nothing else has changed. Yet, one good thing did come out of it: the physical therapist spit-balling a diagnosis of trochanteric bursitis. My chiropractor is confident he can make adjustments with my orthotics to compensate and hopefully remedy this. And in the meantime I’ve been doing ultrasound on the hip and avoiding taking the stairs any more than is necessary. 

It is all a lot to process. The anxiety and pain and depression feeds into every aspect of my life. I would like to “feel better,” not just pain wise, but also this cloudy, heavy, dark feeling of dread and melancholy that follows me most days. I feel this is a physical defect with the wiring of my amygdala, it’s not just MERELY a matter of changing my thoughts. I try to control what I can, and insulate myself from futile and stressful situations where I have zero control or cannot affect any productive change. But that aside, I still feel like a failure.

I view my problem as a snake with two heads: Physical and Intellectual:

Intellectually, I recognize all the good things in my life. I feel I’ve accomplished some good things in my life, and I’m contented in my marriage and my home.

Physically, I cannot shake this dread and depression, this melancholy feeling, on top of the anxiety, and on top of the pain. 

I power through as best as I can. Life is short. Life is meant to be enjoyed. I try to get out there and do things, have experiences, have friends and good food, and vacations to look forward to, and crochet projects and new recipes to create. And yet, this dread, this albatross around my neck from which I cannot extricate myself.

I know everyone has their ups and their downs, it’s part of the cycle of life. But when one is having good things happen, it’s not healthy or “normal” to be full of dread. It makes me feel like a cynic, and yet I’m not. I’m an idealist, who just is anxious and depressed and in pain.

I’m just trying to enjoy what time I have left on Planet Earth, and yet this nebulous force in my head is interfering with my goals and intentions nearly at every turn.